BLS Hodgkin and Non-Hodgkin Lymphomas (2024) PDF

Blood and Lymphatic System Dr. Raya D. Marji, M.D. Al-Balqa Applied University Office: O505 Lymphoid Neoplasm: Malignant tumors of lymphoid tissue characterized by abnormal proliferation of B and T cells in the lymphoid tissue. 1. Precursor B-cell neoplasm. 2...

Blood and Lymphatic System Dr. Raya D. Marji, M.D. Al-Balqa Applied University Office: O505 Lymphoid Neoplasm: Malignant tumors of lymphoid tissue characterized by abnormal proliferation of B and T cells in the lymphoid tissue. 1. Precursor B-cell neoplasm. 2. Mature B Neoplasm. ⑤min  B-cel B & P- T ⑧ ~ ~ d ~ is  3. Ji Sig · ·S ↑ II - paraaoriy, I.,  (H2) - ~ ~ w W ensse ↑ S · i.55  or cell &Is 3s * : 15. I Leukemia: Tumors that involve the bone marrow and peripheral blood predominantly. Lymphoma: Tumors that involve lymph nodes or other organs predominantly. B-cell Plasma cell myeloma is confined to the bones as discrete masses or ↓active Plasma bone marrow with no lymph node or peripheral blood involvement. # AB Neoplastic proliferations are monoclonal, while reactive conditions are polyclonal. Lymphoid neoplasms often disrupt normal immune function. Both immunodeficiency and autoimmunity may be seen. - - - - => - X Lymphoma: Hodgkin vs Non-Hodgkin: Hodgkin Lymphoma: d -> or B-cell origin. Arise in a single lymph node or chain of lymph nodes and spread characteristically in a stepwise fashion to the anatomically contiguous nodes then spleen, liver and BM. ~ Bimodal age distribution: ◦ Between 20 and 30 years of age. ◦ and > 50 years of age. Cervical and supraclavicular nodes are the most commonly affected Clinical presentation: I Painless lymphadenopathy. B-symptoms: ❑Fever ❑Night sweats ❑Weight loss (10% of body weight). r Splenomegaly in 16% of the cases. W Anemia due to bone marrow involvement in 5% of the cases. Morphology: 1. Neoplastic cells ((Reed-Sternberg cells (RS)) (derived from B cells, minor fraction). 2. Immunologic reaction to tumor: Lymphocytes Histiocytes. Eosinophils Plasma cells. Neutrophils. Fibroblasts and fibrous tissue. Morphologic Features of CLASSIC Reed- Sternberg Cells 1. Large (15-45 μm in diameter). e 2. Enlarged polylobated nucleus. 3. Huge round inclusion-like nucleoli. 4. Abundant, slightly eosinophilic cytoplasm. The CLASSIC RS cells with two mirror-image nuclei or nuclear lobes, each containing a large (inclusion- like) acidophilic nucleolus surrounded by a distinctive clear zone; together they impart an owl- eye appearance.  Variants of Reed-Sternberg cells I - 1. Hodgkin cells (Mononuclear variant): Insufficient for diagnosis. 2. Mummified cells: dark smudge degenerating cells with pyknotic ~ nuclei and eosinophilic cytoplasm. - 3. Lacunar cells: Large polylobated nuclei surrounded by pale cytoplasm and contain inconspicuous nucleoli. / 4. (LP) L&H cells: cells with hyperlobated nuclei, finely granular chromatin and inconspicuous small nucleoli. RS cell variants: Immunophenotyping Of HL * 1. Classical HL: RS:CD45-, CD20-, CD15+, CD30+, weak variable PAX5+ 2. NLPHL: RS:CD45+, CD20+,strong PAX5, CD15-, CD30-  cells RS large Classic Hodgkin Lymphoma: > - CD30 : Positive PAX5: Positive (faint)  Classical Hodgkin Lymphoma e (1) Nodular Sclerosis: This is the most common form. M=F. Has a striking propensity to involve the lower cervical, supraclavicular and mediastinal lymph nodes. More in adolescents or young adults. Overall prognosis is excellent. EBV - Morphology: Collagen bands that divide the lymphoid tissue into circumscribed nodules. The cellular infiltrate may show varying proportions of lymphocytes, eosinophils, histiocytes and lacunar cells.  The lacunar cell (variant of the RS cell, large and has a single multilobate nucleus with multiple small nucleoli and an abundant, pale-staining cytoplasm) In formalin-fixed tissue, the cytoplasm often retracts, giving rise to the appearance of cells lying in empty spaces, or lacunae. Classical Hodgkin Lymphoma (2) Mixed Cellularity - This is the most common form in patients > 50 yr. There is a Male predominance. Classic RS cells are plentiful within a distinctive heterogeneous cellular infiltrate, which includes small lymphocytes, eosinophils, Toplasma cells and benign histiocytes. More patients have disseminated disease and systemic manifestations. EBV association. Very good prognosis.  Morphology: The normal architecture is S effaced by Reed Sternberg and ⑤S mononuclear Hodgkin (RS+H) (white solid arrow) cells in a background of small lymphocytes, epithelioid histiocytes, and eosinophils. Classical Hodgkin Lymphoma (3) Lymphocyte Rich: The reactive lymphocytes make up most of the cellular infiltrate. M>F, older adults. This entity is distinguished from the lymphocyte predominance type by the presence of frequent mononuclear variants and diagnostic Reed-Sternberg cells with a “classical” immunophenotypic profile. EBV association. Very good to excellent prognosis.  Mononuclear Hodgkin cells and one Reed-Sternberg cell in a background of small lymphocytes. Classical Hodgkin Lymphoma (4) Lymphocyte depleted An aggressive form, affects older patients. M>F. EBV association. Characterized by paucity of lymphocytic cells with presence of numerous pleomorphic, mummified RS cells with maximum areas of necrosis. It has poor prognosis.  Many Reed-Sternberg cells and variants are present, and small lymphocytes are depleted. Non-Classical Hodgkin Lymphoma Nodular Lymphocyte predominant (NLPHL) 5% of Hodgkin lymphoma. I Shows nodules with many small resting lymphocytes admixed with a variable number of histiocytes. X eosinophils Other types of reactive cells, such as eosinophils, neutrophils, x neutrophils and plasma cells, are scanty or absent, and classic RS cells are xplasma cells extremely difficult to find. X RS cell O Scattered among the reactive cells are lymphohistiocytic (L&H) variant RS cells that have a delicate multilobed, puffy nucleus that has been likened to popcorn pattern called ( popcorn cells). = Affects predominantly young males. & Non-Classical Hodgkin Lymphoma Nodular Lymphocyte predominant (NLPHL): LP cells: CD20: Positive po Clinical Staging Of Hodgkin And Non-Hodgkin Lymphomas (Ann Arbor Classification): Stage I : Involvement of a single lymph node region (I) or - involvement of a single extra lymphatic organ or tissue Ie. - - 2. Stage II : Involvement of two or more lymph node regions on the 1 1 same side of the diaphragm alone (II) or with involvement of - limited contiguous extra-lymphatic organs or tissue II e. Stage III : Involvement of lymph node regions on both sides of the diaphragm (III), which may include the spleen (IIIs), limited contiguous extra-lymphatic organ or site (IIIe), or both (IIIes). Stage IV : Multiple or disseminated foci of involvement of one or more extra-lymphatic organs or tissues with or without lymphatic involvement - Non-Hodgkin’s Lymphoma  Higheasy poor response to therapy small -> lymphoma - -> leukemia  q C is & Iso ↳ -8 jx5000 cell/microliter with or without nodal or extra-nodal involvement, the patient is diagnosed as CLL, if